Single port instrument access device

Abstract

Disclosed are medical devices for surgical procedures, especially procedures that involve the manipulation of surgical instrument end effectors close to the skin surface at an incision site. In accordance with some embodiments, an instalment access device is configured to couple to a wound retractor at a distal end of the device and to receive a multiple instrument entry guide in a port at the proximal end of the instrument access device, with an envelope ( 822 ) between the distal ( 804 ) and proximal ( 812 ) ends defining a sealed cavity for maintaining insufflation pressure. Various embodiments provide means for rotating an assistant port in the envelope about a port that receives the instrument entry guide without twisting the envelope. Also disclosed are various envelope shapes. Also disclosed is an instrument entry guide that aligns surgical instrument shafts.

1 . A medical device comprising:
 an envelope comprising distal and proximal openings;   a distal coupling component positioned in and coupled to the distal opening; and   a proximal coupling component positioned in and coupled to the proximal opening, the proximal coupling component comprising an entry guide port;   wherein:
 the envelope includes a proximal section and a distal section, the distal section coupled to the proximal section, the proximal opening being in the proximal section, and the distal opening being in the distal section; 
 a maximum diameter of the envelope is located at a Junction between the proximal and distal sections of the envelope; and 
 the envelope, on a condition that the envelope is pressurized with insufflation gas, extends radially outward beyond the distal and proximal openings. 
   
     
     
         2 . The medical device of  claim 1 , wherein the envelope, on the condition that the envelope is pressurized with insufflation gas, comprises a spherical shape. 
     
     
         3 . The medical device of  claim 1 , wherein the envelope, on the condition that the envelope is pressurized with insufflation gas, comprises an oblate spherical shape. 
     
     
         4 - 6 . (canceled) 
     
     
         7 . The medical device of  claim 1 , wherein the envelope, on the condition that the envelope is pressurized with insufflation gas, comprises a barrel shape. 
     
     
         8 . (canceled) 
     
     
         9 . The medical device of  claim 1 , wherein the envelope, on the condition that the envelope is pressurized with insufflation gas, comprises an ovoid shape. 
     
     
         10 - 11 . (canceled) 
     
     
         12 . The medical device of  claim 1 , wherein the junction at which the distal section is coupled to the proximal section of the envelope is located below a plane that bisects the envelope longitudinally. 
     
     
         13 . The medical device of  claim 1 , wherein a maximum diameter of the envelope is larger than a height of the envelope. 
     
     
         14 . The medical device of  claim 1 , wherein the envelope comprises a thermoplastic polyurethane. 
     
     
         15 . The medical device of  claim 1 , wherein the distal coupling component is configured to be coupled to a medical port device. 
     
     
         16 . The medical device of  claim 1 , wherein,
 the proximal coupling component comprises a countermotion assembly coupled to the proximal opening of the envelope;   the countermotion assembly comprises the entry guide port and an assistant port; and   the entry guide port and the assistant port are both eccentrically positioned on the countermotion assembly.   
     
     
         17 . The medical device of  claim 16 , wherein the proximal coupling component further comprises:
 an entry guide receptacle received in the entry guide port; and   a multiple instrument entry guide received in the entry guide receptacle.   
     
     
         18 . The medical device of  claim 17 , further comprising an entry guide seal coupled to the entry guide receptacle and sealingly engaged with the multiple instrument entry guide. 
     
     
         19 . The medical device of  claim 16 , wherein the countermotion assembly is configured such that the assistant port rotates eccentrically relative to and around the entry guide port. 
     
     
         20 . The medical device of  claim 1 , further comprising an assistant port coupled to the envelope between the proximal opening and the distal opening of the envelope. 
     
     
         21 . The medical device of  claim 20  further comprising an instrument seal in the assistant port. 
     
     
         22 . (canceled) 
     
     
         23 . A medical device comprising:
 an envelope comprising a proximal section and a distal section, the proximal section comprising a proximal opening, the distal section being joined to the proximal section and comprising a distal opening, a center axis being defined through the proximal and distal openings;   means for receiving one or more instruments, the means for receiving being coupled to the envelope at the proximal opening;   means for coupling to a medical port device, the means for coupling being coupled to the envelope at the distal opening;   wherein:   a maximum diameter of the envelope is located at a junction between the proximal and distal sections of the envelope; and   on a condition that the envelope is insufflated by a gas, the envelope comprises a generally ovoid shape with the proximal section of the envelope extending a first distance along the center axis and the distal section of the envelope extending along a second distance along the center axis less than the first distance.   
     
     
         24 . The medical device of  claim 23 , wherein at least a part of the proximal section is transparent. 
     
     
         25 . The medical device of  claim 23 , wherein:
 the proximal section consists of a first individual piece; and   the distal section consists of a second individual piece.   
     
     
         26 . The medical device of  claim 23 , wherein:
 the envelope comprises a third opening between the proximal and distal openings; and   the medical device comprises second means for receiving one or more instruments, the second means for receiving being in the third opening of the envelope.   
     
     
         27 . The medical device of  claim 23 , wherein:
 the means for receiving comprises a first opening configured to receive a plurality of teleoperated instruments; and
 the medical device comprises means for counter motion configured to rotate the proximal opening of the envelope around the means for receiving in a first angular displacement as the means for receiving rotates around the first opening in a second angular displacement equal to and in an opposite direction from the first angular displacement.